What does practice development (PD) offer mental health-care contexts? A comparative case study of PD methods and outcomes

Factors that optimise the impact of continuing professional development in nursing: A rapid evidence review

OBJECTIVES

Continuing professional development is essential for healthcare professionals to maintain and acquire the necessary knowledge and skills to provide person centred, safe and effective care. This is particularly important in the rapidly changing healthcare context of the Covid-19 pandemic. Despite recognition of its importance in the United Kingdom, minimum required hours for re-registration, and related investment, have been small compared to other countries. The aim of this review is to understand the factors that optimise continuing professional development impact for learning, development and improvement in the workplace.

DESIGN

A rapid evidence review was undertaken using Arksey and O'Malley's (2005) framework; identifying a research question, developing a search strategy, extracting, collating and summarising the findings.

REVIEW METHODS

In addressing the question 'What are the factors that enable or optimise CPD impact for learning, development and improvement in the workplace at the individual, team, organisation and system level?' the British Nursing Index, the Cochrane Library, CINAHL, HTA database, King's Fund Library, and Medline databases were searched for key terms. A total of 3790 papers were retrieved and 39 were included.

RESULTS

Key factors to optimising the impact of nursing and inter-professional continuing development are; self-motivation, relevance to practice, preference for workplace learning, strong enabling leadership and a positive workplace culture. The findings reveal the interdependence of these important factors in optimising the impact of continuing professional development on person-centred care and outcomes.

CONCLUSION

In the current, rapidly changing, healthcare context it is important for educators and managers to understand the factors that enhance the impact of continuing professional development. It is crucial that attention is given to addressing all of the optimising factors in this review to enhance impact. Future studies should seek to measure the value of continuing professional development for people experiencing care, nurses and the wider organisation.

Optimal NHS service delivery to care homes: a realist evaluation of the features and mechanisms that support effective working for the continuing care of older people in residential settings

Background

Care homes are the institutional providers of long-term care for older people. The OPTIMAL study argued that it is probable that there are key activities within different models of health-care provision that are important for residents’ health care.

Objectives

To understand ‘what works, for whom, why and in what circumstances?’. Study questions focused on how different mechanisms within the various models of service delivery act as the ‘active ingredients’ associated with positive health-related outcomes for care home residents.

Methods

Using realist methods we focused on five outcomes: (1) medication use and review; (2) use of out-of-hours services; (3) hospital admissions, including emergency department attendances and length of hospital stay; (4) resource use; and (5) user satisfaction. Phase 1: interviewed stakeholders and reviewed the evidence to develop an explanatory theory of what supported good health-care provision for further testing in phase 2. Phase 2 developed a minimum data set of resident characteristics and tracked their care for 12 months. We also interviewed residents, family and staff receiving and providing health care to residents. The 12 study care homes were located on the south coast, the Midlands and the east of England. Health-care provision to care homes was distinctive in each site.

Findings

Phase 1 found that health-care provision to care homes is reactive and inequitable. The realist review argued that incentives or sanctions, agreed protocols, clinical expertise and structured approaches to assessment and care planning could support improved health-related outcomes; however, to achieve change NHS professionals and care home staff needed to work together from the outset to identify, co-design and implement agreed approaches to health care. Phase 2 tested this further and found that, although there were few differences between the sites in residents’ use of resources, the differences in service integration between the NHS and care homes did reflect how these institutions approached activities that supported relational working. Key to this was how much time NHS staff and care home staff had had to learn how to work together and if the work was seen as legitimate, requiring ongoing investment by commissioners and engagement from practitioners. Residents appreciated the general practitioner (GP) input and, when supported by other care home-specific NHS services, GPs reported that it was sustainable and valued work. Access to dementia expertise, ongoing training and support was essential to ensure that both NHS and care home staff were equipped to provide appropriate care.

Limitations

Findings were constrained by the numbers of residents recruited and retained in phase 2 for the 12 months of data collection.

Conclusions

NHS services work well with care homes when payments and role specification endorse the importance of this work at an institutional level as well as with individual residents. GP involvement is important but needs additional support from other services to be sustainable. A focus on strategies that promote co-design-based approaches between the NHS and care homes has the potential to improve residents’ access to and experience of health care.

Funding

The National Institute for Health Research Health Services and Delivery Research programme.